2a NSAIDs and other non-opioids in chronic pain

Non-opioids are first-line drugs for long-term pain therapy. They are effective and have a low incidence of side-effects. There are differences between non-opioids, allowing for differential indications in order to improve efficacy as well as safety. While patients with low back pain and osteoarthritis are often treated well using pure analgesics, patients with rheumatoid arthritis, and in particular those with ankylosing spondylitis, require the most potent anti-inflammatory drugs. Patients with cancer pain of moderate-to-severe intensity also benefit from them, but this is limited by the progression of the disease and the ceiling effect of non-steroidal anti-inflammatory drugs (NSAIDs). Regular endoscopic investigation of the upper gastro-intestinal tract should be considered for the prevention of fatal side-effects in patients at risk. The choice of drugs for treatment must be based on outcome studies of high quality. According to the selection of studies presented, a few drugs can be ranked, those with highest safety first: ibuprofen, tenidap, fenbufen, aceclofenac, indomethacin, ketorolac, diclofenac, tenoxicam, piroxicam and ASA.